Search

This paper studies the creation of organisations via people processing (Prottas 1979), taking as its case study a new and developing family centre that aims to offer various social and health services under the same roof. The study draws on ethnomethodology, meaning that organisations are herein understood as being created and continuously produced in and through interaction. The data consist of 11 audio-recorded meetings from the centre's steering group, which includes managers from different service fields and welfare agencies. In analysing the creation of the centre through people processing, this paper scrutinises how the meeting participants orient themselves toward and produce the centre's client categories, what characteristics they connect to these categories, and how they do boundary work regarding which categories belong or not to the centre's target groups. The meeting participants produce three different family based client categories. The first category is ordinary families, those without any special problems who just pop into the centre to see other people. These families are distinguished from the second category, best matching families, who are defined as having problems that would benefit from the integrated, multi-professional work conducted at the centre. The third category, families with too specific needs, refers to client groups whose service needs are at least partly beyond the centre's expertise and resources. The centre needs these people-processing activities to make sense of its mission, clients and co-partners; this ongoing reasoning process allows the emerging centre to exist and find its place in the local service system. [ABSTRACT FROM AUTHOR]

Aging is a challenging process for people with gender nonconformity. Indeed, the older transgender population faces several disparities in accessing and using health care and social support services. Furthermore, the clinical management of gender transition in later life is empirical since clear research evidence is lacking. This paper aimed to present the problems encountered by older transgender adults in their access to social support and health care and to propose insightful solutions to address them both from a social and medical/nursing perspective. Trans elders face profound disparities in health and social care due to factors associated with limited accessibility to health services, social restrictions, administrative failures, and physical vulnerabilities. The medical treatment of older transgender adults also needs a careful approach to achieve satisfying gender affirmation without clinically significant risks. The potential induction of hormone-sensitive malignancies and the provocation of major adverse vascular events are the main concerns. Gender transition in older adults without a prior history of following gender-affirming therapy is challenging due to biological factors related to advanced age. Caring for elderly trans people unfolds at multiple levels. International organizations and governmental bodies should address the underprivileged status of elderly transgender people by creating and implementing inclusive policies. Safe and respectful clinical and residential environments and the formation of clearer medical guidelines could meet the unique needs of older trans adults. Care providers must advocate for their patients and be equipped to provide safe and effective services. [ABSTRACT FROM AUTHOR]

Describes the contribution of a series of focus groups and a revised discussion paper to the evolution of health care reform in South Australia. Impact of health care reform on health care agencies; Reasons for the struggles of evaluators to evaluate health care reform programs; Relationships between bureaucracy and health care service providers.

Objective: This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. Conclusion: The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses. [ABSTRACT FROM AUTHOR]

Australia's Fifth National Mental Health Plan required governments to report, not only on the progress of changes to mental health service delivery, but to also plan for services that should be provided. Future population demand for treatment and care is challenging to predict and one solution involves modelling the uncertain demands on the system. Modelling can help decision-makers understand likely future changes in mental health service demand and more intelligently choose appropriate responses. It can also support greater scrutiny, accountability and transparency of these processes. Australia has an emerging national capacity for systems modelling in mental health which can enhance the next phase of mental health reform. This paper introduces concepts useful for understanding mental health modelling and identifies where modelling approaches can support health service planners to make evidence-informed decisions regarding planning and investment for the Australian population. [ABSTRACT FROM AUTHOR]

Objective: In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health–related ED episodes in Australian public hospitals between 2016-17 and 2020-21. Method: We descriptively analysed Australian Institute of Health and Welfare data for mental health–related ED presentations, outcomes and 5-year trends for Australian public hospitals. Results: There were more than 300,000 Australian mental health–related ED presentations in 2020-21. Presentations increased by an average annual rate of 2.8% between 2016-17 and 2020-21, commonly involving first responder (police, paramedic) attendance. From 2016-17 to 2020-21, the average annual rate of mental health–related ED presentations receiving a triage category of resuscitation increased by 13.7%, emergency by 9.4% and urgent by 4.7%. 90% of MH-related ED presentations were completed within 14 h, which was longer than the 90th percentile for all ED presentations (up to 8 h). Conclusions: Current mental health policies have not stemmed the rising tide of ED presentations. Mental health–related ED presentations are increasing in number and severity, likely due to health systemic and societal factors. Psychiatry patients stay longer in EDs than other patients. Healthcare reforms should be targeted to provide the best outcome based on principles of equity of access. [ABSTRACT FROM AUTHOR]

In this invited paper, we critique Barth and colleagues' (2021). "Research to Consider While Effectively Re-Designing Child Welfare Services" paper that presents 10 commonly held misconceptions in child welfare to provide a foundation for child welfare system reform. We argue that research alone cannot guide the reform of the child welfare system. Rather, we argue that people with lived expertise in the child welfare system and programs must be involved in all parts of collaborations in order to re-design child welfare. Research has limitations and privileging it in setting any reform agenda and efforts is potentially dangerous. We conclude that for effective child welfare system re-design to occur, research-policy-practice partnerships must be built with people with lived expertise in the child welfare system and programs. [ABSTRACT FROM AUTHOR]

Objectives: This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme – a major reform to the financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users. Methods: We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions. Results: We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty. Conclusion: Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out. Implications: This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level. [ABSTRACT FROM AUTHOR]

Objective: To describe a recent process by which mental health service sector leaders identified key elements of strategic, systemic and structural mental health reform. These elements could guide an incoming Federal government. Method: The paper describes the process undertaken by the Sydney Mental Health Policy Forum between 2019 and 2022. This work generated principles, key domains and finally a set of actions. Results: Five immediate actions were identified that are cost neutral or require minimal investment. Five further actions requiring realignment of existing funds and/or new funds were also identified. Conclusions: The task of mental health reform in Australia is both large and overdue. Continued investment in fragmented or piecemeal programmes and services will not propel desired change. Reform must facilitate new regional control of planning, funding and responding to community mental health needs. The actions identified by the Forum set out a menu of opportunities to guide reform over the life of the next Parliament, starting now. [ABSTRACT FROM AUTHOR]

The Institute of Medicine's (IOM, 2011) Future of Nursing report is an important study of the healthcare system that reflects significant ways nurses may drive transformational change. In this paper, the author explores the Key Elements from the IOM's (2011) Future of Nursing report in light of Parse's (2008) leading-following model and community change concepts (Parse, 2003, 2012). This exploration is logical in that to implement the IOM's Key Elements, community change and leadership are necessary. [ABSTRACT FROM AUTHOR]

Objectives: The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health. Methods: We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB. Results: HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes. Conclusions: Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact. [ABSTRACT FROM AUTHOR]

Aims: Nordic welfare states have achieved admirable population health profiles as a result of public policies that provide economic and social security across the life course. Denmark has been an exception to this rule, as its life expectancies and infant mortality rates since the mid-1970s have lagged behind the other Nordic nations and, in the case of life expectancy, behind most Organisation for Economic Co-operation and Development nations. Methods: In this review paper, we identify a number of new hypotheses for why this may be the case. Results: These hypotheses concern the health effects of neo-liberal restructuring of the economy and its institutions, the institution of flexi-security in Denmark’s labour market and the influence of Denmark’s tobacco and alcohol industries. Also of note is that Denmark experienced higher unemployment rates during its initial period of health stagnation, as well as its treatment of non-Western immigrants and high wealth inequality and, until recently, the fact that Denmark did not systematically address the issue of health inequalities. Conclusions: These hypotheses may serve as covering explanations for the usually provided accounts of elevated behavioural risks and psychosocial stress as being responsible for Denmark’s health profile. [ABSTRACT FROM AUTHOR]

Personality disorders have received limited recognition as a public health priority, despite the publication of treatment guidelines and reviews showing effective treatments are available. Inclusive approaches to understanding and servicing personality disorder are required that integrate different service providers. This viewpoint paper identifies pertinent issues surrounding early intervention, treatment needs, consumer and carer experiences, and the need for accurate and representative data collection in personality disorder as starting points in mental health care reform. [ABSTRACT FROM AUTHOR]

Starting in 2002, the UK Labour Government of 1997–2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients’ choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government’s desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency.The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows:an evaluation of the implementation and outcomes of care planning for people with long-term conditions;an evaluation of the personal health budget pilots;an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; andan evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all.This Supplement includes papers from each project.The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying and improving the policies. These findings have continuing relevance since both the 2008 White Paper’s policies, and the issues they were focused on remedying, remain central to the current Coalition Government’s reform agenda. [ABSTRACT FROM PUBLISHER]

Objectives: This paper examines how the interaction between financial and clinical risk at two critical phases of health care reform in England has been experienced by frontline staff caring for vulnerable patients with long term conditions. Methods: The paper draws on contracting theory and two interdisciplinary and in-depth qualitative research studies undertaken in 1995 and 2007. Methods common to both studies included documentary analysis and interviews with managers and front line professionals. The 1995 study employed action-based research and included observation of community care; the 2007 study used realistic evaluation and included engagement with service user groups. Results: In both reform processes, financial risk was increasingly devolved to frontline practitioners and smaller organizational units such as GP commissioning groups, with payment by unit of activity, aimed at changing professionals' behaviour. This financing increased perceived clinical risk and fragmented the delivery of health and social care services requiring staff efforts to improve collaboration and integration, and created some perverse incentives and staff demoralisation. Conclusions: Health services reform should only shift financial risk to frontline professionals to the extent that it can be efficiently borne. Where team work is required, contracts should reward collaborative multiprofessional activity. [ABSTRACT FROM AUTHOR]

This paper describes current progress for an information management project in a medium-sized rural hospital after the first four months of the one-year project. In particular, the article examines some of the project outcomes to date as these relate to the National Hospitals and Health Reform recommendations for the smart use of data, information and communication. The paper identifies a number of important challenges and issues that have been addressed by the project and proposes that the project findings may be used to inform similar projects in other settings. These findings relate to clinician requirements for reports, investment in human resources, development, and time for information management activities. An understanding of data collected, information systems, and presentation of clinician data are also important. The benefits of information sharing in assisting quality improvement activities are particularly relevant but, more importantly, they can engage and involve clinicians in the use of information. The importance of local data, information, and knowledge is described. Finally, issues for the health information management profession, such as working collegially and sharing knowledge and expertise, are outlined. [ABSTRACT FROM AUTHOR]

The translation of information into practice is a well-recognised challenge for the health sector. In the primary healthcare sector, the last decade has seen an explosion of information generated by health systems, universities and a range of other sources. Without a system for translating that knowledge into practice and sharing it in a comprehensible form, it will remain meaningless to most practitioners. We propose the establishment of Knowledge Networks as a promising method for supporting the rapid adoption and generation of health information within the primary health care sector to advance health care services. These networks will be particularly important to the implementation of the national reform agenda, responsive decision-making and the translation of new frameworks or competencies into practice. This paper describes how interdisciplinary Knowledge Networks could be established focusing on a number of priority health research areas. Local Knowledge Networks would be used as a platform to support a collaborative web of evidence designed to influence health policy and planning. Our experience with Knowledge Networks indicates that they must be comprised of health professionals from Divisions of General Practice, researchers, policy-makers, consumers, government and non-government sectors. This paper will describe these networks and show how they might support the translation of knowledge into practice, thus driving systematic and institutional change. [ABSTRACT FROM AUTHOR]

Objectives: This paper presents preliminary evaluative findings from research on key areas of concern to Māori and forms part of a wider project on the 2001 health system reforms in New Zealand. The paper reports on the development and implementation of the Māori Health Strategy, representation in decision making at governance level in District Health Boards, the inclusion of the Treaty of Waitangi in legislation and workforce issues. Methods: Key informant interviews with 35 Māori and non-Māori respondents, in addition to data from five case study districts, were thematically analysed to gain an understanding of views on the health system reforms to date. Results: The development of a Māori Health Strategy and the mandatory inclusion of Māori in governance and consultation processes have had a positive effect on Māori participation in the public health sector. Whereas previously Māori participation was concentrated in health service provision, the inclusion of specific provisions in the New Zealand Public Health and Disability Act 2000 has resulted in greater Māori inclusion in governance, planning and decision-making roles. However, there are concerns over strategy implementation, sustainability and workforce development. Conclusions: Overall, the findings at this stage indicate that there is support for the post-2000 model. Māori and non-Māori alike have identified positive features of the model that could go some way towards contributing to improved Māori health. However challenges still remain. [ABSTRACT FROM AUTHOR]

This paper focuses on two areas of innovation currently articulating the agenda of personalized medicine (PM): the discourse of empowerment in health-care reforms and the rise of molecular epigenomics. We align these two developments as discursive and technical resources, focusing on their nascent interplay in shaping alternative sociotechnical imaginaries of PM. Our work aims at inaugurating an intellectual programme on the distinct futures of policy- and identity-making that are being catalysed around epigenomic technoscience, as well as to provide an operational map of its potential synergies with pre-existing socio-political discourses of empowerment in PM. This roadmap advances our understanding of how the intersection of epigenomics with dominant policy discourses becomes a resource to shape roles and obligations of citizens, patients and health-care actors in the emergence of PM. [ABSTRACT FROM AUTHOR]

Objective To review the evidence on commissioning schemes involving clinicians in the United Kingdom National Health Service, between 1991 and 2010; report on the extent and impact of clinical engagement; and distil lessons for the development of such schemes both in the UK and elsewhere. Methods A review of published evidence. Five hundred and fourteen abstracts were obtained from structured searches and screened. Full-text papers were retrieved for UK empirical studies exploring the relationship between commissioners and providers with clinician involvement. Two hundred and eighteen published materials were reviewed. Results The extent of clinical engagement varied between the various schemes. Schemes allowing clinicians to act autonomously were more likely to generate significant engagement, with ‘virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement) observed. Engagement of the wider general practitioner (GP) membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Conclusion Evidence for a significant impact of clinical engagement on commissioning outcomes is limited. Initial changes are likely to be small scale and to focus on services in primary care. Engagement of GP members of primary care commissioning organizations is an important determinant of progress, but generates significant transaction costs. [ABSTRACT FROM AUTHOR]

The Patient Protection and Affordable Care Act (PPACA) is a complex piece of legislation that requires a high level of collaboration between actors at multiple levels of government, federal and state, to successfully implement its provisions. However, the polarized political environment in which the law was passed has created roadblocks for implementation, with Republican governors claiming that they will not negotiate with federal agencies over many of the law's key details. Though the decisions of governors and of state legislatures are critical for policy implementation, much of the effort will require administrators at multiple levels of government, and often with different preferences, to collaborate with one another to set policy priorities and oversee the operation of key features of the law. This paper reports on the results of a recent in-depth survey of state-level administrators that examines the extent of state-federal collaboration to implement health reform. Using qualitative and quantitative indicators, I find that state administrators' engagement in collaborative activity is generally robust. Even so, state administrators' perceptions of their relationship with federal agents appear to vary by the partisan compositions of their respective states, suggesting that political conflict over the reform may pose some dilemmas for future implementation efforts. [ABSTRACT FROM AUTHOR]

This paper presents a critical analysis of the development of government policy and practice on health research, development and innovation over the last 25 years -- starting from the publication of a seminal report from the House of Lords Science and Technology Committee in 1988. We first set out to map and analyse the trends in ideas and thinking that have shaped research policy and practice over this period, and to put the development of health research, development and innovation in the wider context of health system reforms and changes. We argue that though this has been a transformative period for health research, rather less progress has been made in the domains of development and innovation, and we offer an analysis of why this might be the case. Drawing on advances in our understanding about how research informs practice, we then make the case for a more integrative model of research, development and innovation. This leads us to conclude that recent experiments with Collaborations for Leadership in Applied Health Research and Care and Academic Health Science Centres and Networks offer some important lessons for future policy directions. [ABSTRACT FROM AUTHOR]

To meet the twin goals of cost containment and universal coverage, health care legislators in the US will eventually have to come to grips with the concept of 'compulsion'. This is the main tenet of this paper, which also addresses what compulsion might mean as applied in the context of recent US health care legislation and its implications for the US health care industry. Missing the opportunity to embrace compulsion more fully may lead to cost containment not being achieved, thus threatening the sustainability of the reforms contained in the recently Patient Protection and Affordable Care Act. [ABSTRACT FROM AUTHOR]

The central objectives of the 'Blair/Brown' reforms of the English NHS in the 2000s were to reduce hospital waiting times and improve the quality of care. However, critics raised concerns that the choice and competition elements of reform might undermine socioeconomic equity in health care. By contrast, the architects of reform predicted that accelerated growth in NHS spending combined with increased patient choice of hospital would enhance equity for poorer patients. This paper draws together and discusses the findings of three large-scale national studies designed to shed empirical light on this issue. Study one developed methods for monitoring change in neighbourhood level socioeconomic equity in the utilization of health care, and found no substantial change in equity between 2001-02 and 2008-09 for non-emergency hospital admissions, outpatient admissions (from 2004-05) and a basket of specific hospital procedures (hip replacement, senile cataract, gastroscopy and coronary revascularization). Study two found that increased competition between 2003-04 and 2008-09 had no substantial effect on socioeconomic equity in health care. Study three found that potential incentives for public hospitals to select against socioeconomically-disadvantaged hip replacement patients were small, compared with incentives to select against elderly and co-morbid patients. Taken together, these findings suggest that the Blair/Brown reforms had little effect on socioeconomic equity in health care. This may be because the 'dose' of competition was small and most hospital services continued to be provided by public hospitals which did not face strong incentives to select against socioeconomically-disadvantaged patients. [ABSTRACT FROM AUTHOR]

Starting in 2002, the UK Labour government of 1997-2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase individual NHS patient choice of place of elective hospital care and competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. The changes broadly had the effects that proponents had predicted but the effects were mostly modest. Most of the undesirable impacts feared by critics appeared not to have materialized to any discernible extent, at least by early in 2010. Labour's market appeared to have generated stronger incentives for quality and efficiency than its 1990s predecessor with no obvious detriment to equity of access. However, this high level conclusion conceals a far more nuanced and complex picture of both the process of implementation and the impact of the changes, as the papers in this supplement drawn from the HREP show. [ABSTRACT FROM AUTHOR]

The Coalition government’s plans for reform are meant to transform the NHS into a more privately run, competitive system, raising the question as to whether or not the NHS is likely to resemble the US capitalist healthcare industry. The US system will be examined for comparative purposes, followed by an analysis of how far earlier reforms under Conservative and New Labour governments have moved the NHS in that direction. The implications of the White Paper proposals are analysed to determine the degree to which the NHS is destined to become a commodity-producing industry. The tentative conclusion is that while secondary care will be similar in many ways to the US hospital industry, state funding remains a barrier to complete transformation, and what is likely to emerge is a hybrid system in which competition, consolidation, and pressure on the workforce all increase. [ABSTRACT FROM PUBLISHER]

The paper explores psychiatry’s responses to the twentieth-century socio-political currents in Latvia by focusing on social objectives, clinical ideologies, and institutional contexts of Soviet mental health care. The tradition of German biological psychiatry in which Baltic psychiatrists had been trained blended well with the materialistic monism of Soviet psychoneurology. Pavlov’s teaching of the second signal system was well suited to Soviet ideological needs: speech stimuli were seen as a vehicle for moulding the individual’s mind. The transformation in diagnostic practices during the 1970s and 1980s reflected the demise of optimism about the capacity of the self to model itself to the needs of the society. Latvian psychiatry was prepared to embrace more individualistic and pessimistic theories of the self. [ABSTRACT FROM PUBLISHER]

Between 1900 and 1939 the regional government in Catalonia discussed a complete reform of the psychiatric institutions inherited from the nineteenth century. The debate was centred on the Spanish government’s lack of interest in mental health policies and the growing demand for services. The projects developed between 1900 and 1939 opened a wide-ranging discussion on the role of ethnic and cultural factors in shaping mental illness, and the need to adapt the new facilities to the ethnic features of Catalonia. This study explores the production of Catalan psychiatric discourses and their ideological roots, and the development of public policies up to the end of the Spanish Civil War (1936—39). The paper concludes with a discussion of the influence of pre-war Catalan mental health policies on the wartime practice of psychiatry and, later, on the development of the French psychothérapie institutionnelle after World War II. [ABSTRACT FROM PUBLISHER]

In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed. [ABSTRACT FROM PUBLISHER]

Government regulations affect corporations and consumers on a daily basis. For example, environmental and safety regulations in the workplace are administrated by the Occupational Safety and Health Administration (OSHA) under the Department of Labor. OSHA sets and enforces standards in work environment to ensure the safety and health of workers. Other regulatory agencies, such as the National Highway and Transportation Agency (NHTSA), oversee the transportation and the safety of the automobile and truck industry. The U.S. Food and Drug Administration (FDA) plays a major role in approving new drugs on the market and in monitoring drug safety, and it has the power to remove drugs from the market if they are proved to be safety and health problems to the public. However, the mere existence of these regulations often causes impediments to businesses, and the extent of their ultimate usefulness is examined and analyzed in this paper. [ABSTRACT FROM AUTHOR]

Action research in health care is a relatively new research approach, which is adopted when one aim of the research is to bring about change in practice and to research the process of that change. This paper describes the way action research, as a research methodology, can be used to develop palliative care knowledge in generalist care settings. An overview of action research is presented and its relationship to more conventional research paradigms. Two action research projects, undertaken to develop knowledge about end-of-life care for older people in care homes, are used to illustrate the key principles of action research, methods of data collection and data analysis. Finally, the challenges of such, utilising an action research approach and its strengths, are discussed. [ABSTRACT FROM AUTHOR]

Objective: Deficiencies in Australia’s mental health systems persist despite over a decade of mental health reform. Recent developments in e-health provide the opportunity to facilitate health reform and improve services. This paper presents preliminary findings from the implementation of a comprehensive e-health system, called RecoveryRoad , which was designed to augment the routine clinical treatment of depression. Methods: Depressed patients (n = 144) were referred to RecoveryRoad from a public hospital and public and private clinics in Perth, Western Australia. Online features included secure e-consultations, progress monitoring questionnaires, psychoeducation and evidence-based therapy. Treating clinicians had online access to patients’ progress monitoring outcomes and e-consultations. There were two types of adherence reminders: automated email reminders and personalized case management delivered by email and telephone. Results: Adherence to the system was high (from 53% to 84%, depending on the modality of reminder), and self-reported medication adherence was over 90%. Average depression severity declined from severe to mild by the eighth session, a large effect (d = 1.0). Both clinicians and patients were generally satisfied with the programme and reported that it improved clinician–patient relationships. Clinicians also reported that it helped patients to better manage depression. Conclusions: Preliminary findings support the feasibility of comprehensive e-health systems in enhancing the delivery of mental health care. [ABSTRACT FROM AUTHOR]

Objectives: The present paper aims to: (i) describe how the Mental Health Commission in New Zealand works and has contributed to the substantial enhancement of mental health resources and services; (ii) determine whether mental health reform policies will ever be implemented properly without an independent monitor with official influence at the highest levels of government; and (iii) demonstrate how variants on this model work in other Western countries and how it can be adapted to the Federated system in Australia.Conclusions: It is recommended that the Australian National Mental Health Plan 2003-2008 should be complemented by a long-standing national mental health commission (or similarly constituted body), which is also able to report independently from and to the government, with direct access to the Prime Minister, Premiers and Australian Health Ministers. Its aims would be to monitor service effectiveness and identify gaps in service provision, training and performance of the work force, management and government. It would be informed by consumer, carer and provider experience, and by reviews of evidence-based research regarding health needs and cost-effective services. It should accurately cost such service gaps, and advise government on a strategy for implementing them. It could also promote and advise formally on enhancing community awareness, decreasing stigma and discrimination and improving workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

This paper explores the theoretical confusion in explanations of health policies. It does so by distinguishing between the politics of constitutional conflict and the politics of distributional conflict, and analysing their development over time. The first type is epitomized by the collisions between the state and the medical profession in 1911, 1945 and 1989 on the issue of general practice. The second is characterized by a corporatiststyle, institutionalized relationship between the state and the profession between and subsequent to these events. Conclusions are drawn about the limitations of corporatist and other theories and about the methodology of policy analysis. [ABSTRACT FROM AUTHOR]

This paper reviews various theoretical perspectives on organizational change which have been and could be applied to medical organizations. These perspectives are discussed as both filters influencing our observations (research) and mirrors of the shifting dynamics of delivery system reform (policy). We conclude with an examination of how such theories can provide useful insights into our rapidly changing health care system. [ABSTRACT FROM AUTHOR]

The Universitas 21 (U21) organization funded a one-year project to examine global e-health. An e-health steering committee surveyed the opinions of e-health researchers at U21 member schools and conducted a literature review. Information about key themes was analysed and the findings were summarized. The steering committee recommended an eight-step strategy to establish a sustainable endeavour in global e-health. This included implementing a dissemination strategy within the U21 organization to engage a progressively larger community of faculty members and others, and translating e-health knowledge into global practice in those areas in which the U21 has special expertise. While the recommendations in the discussion paper are specific to the U21 organization, the e-health steering committee believes they can be generalized and applied to any globally minded educational or research institutions seeking to contribute to e-health. [ABSTRACT FROM AUTHOR]

The article discusses the paper by Anselm Strauss and his colleagues that reports a particular observation study of life in the ward within two psychiatric hospitals. The authors started the discussion with the depiction of clinical work organization and the examination of its benchmarking potential. The contribution of the study to the organization studies is also included. The conclusion is derived through identifying the implications of the study for current efforts on reform.

The article discusses the background and objectives of the Mental Health Professionals' Association (MHPA), which was convened in early 2006 by the Royal Australian and New Zealand College of Psychiatrists. It was made up of interdisciplinary health professionals in mental health care to advocate for and advise on effective mental health reform. Furthermore, the paper introduces the objectives of the association's Mental Health Interdisciplinary Network (MHIN) project.

The article presents information on the effect of health care reforms on gender equity in health. The paper assesses the impact of four key health care reforms, including decentralization, financing, privatization and priority setting. Privatization, when accompanied by emphasis on maximizing efficiency and reducing costs, may have an important impact on gender equity in health care.